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Thromboangiitis Obliterans (Buerger Disease)

Thromboangiitis Obliterans (Buerger Disease) is a topic covered in the 5-Minute Clinical Consult.

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  • One of the causes of critical limb ischemia
  • Nonatherosclerotic vasculitis of small- and medium-sized arteries and veins resulting in segmental occlusion of the distal extremity vasculature; caused by inflammatory thrombo-occlusive disease
  • Characterized by resting pain, ischemic ulcerations, and gangrene of the digits of hands and feet
  • Patients are typically young (age <50 years), male smokers.
  • Synonym(s): Buerger disease


  • The prevalence has decreased in North America over the past 30 years.
  • Most prevalent in Eastern Europe, Mediterranean, and Asian countries

  • 11 to 30/100,000 persons/year
  • Predominant age: 20 to 40 years
  • Predominant sex: male > female; increasingly diagnosed in women, perhaps due to increased smoking
  • Estimates range from as low as 0.5% to 5.5% in Western Europe, to 45–63% in India, to 80% in Israel among those of Ashkenazi ancestry.
  • Accounts for 5 and 16% of patients hospitalized for arterial occlusive disease in Europe and Japan, respectively
  • 13/100,000 U.S. population
  • Overall occurrence is decreasing worldwide.

Geriatric Considerations
Not common in the elderly

Pediatric Considerations
Rare in children. Consider in adolescent smokers presenting with claudication, digital ulcers, or digital gangrene.

Etiology and Pathophysiology

  • Idiopathic, but it demonstrates impaired endothelium-dependent vasorelaxation and decreased peripheral sympathetic outflow. Nonendothelial mechanisms of vasodilation are intact.
  • Segmental infiltration of inflammatory cells in vessel wall leads to thrombotic occlusion.
  • Highly cellular and inflammatory thrombus with relative sparing of the blood vessel wall
  • Smoking predisposes to occurrence.
  • Genetic factors implicated
  • Autoimmune component which is not fully understood
  • Chronic anaerobic periodontal infection

  • Greater prevalence of HLA-A54, HLA-A9, and HLA-B5
  • HLA-B12 antigen may be associated with disease resistance.
  • Familial cases rarely reported

Risk Factors

  • Smoking as little as 1 to 2 cigarettes daily, chewing tobacco, snuff, and nicotine replacement are all risk factors for thromboangiitis obliterans (TAO).
  • Chronic anaerobic periodontal infection also may play a role in the development of TAO.

General Prevention

Tobacco cessation

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Stephens, Mark B., et al., editors. "Thromboangiitis Obliterans (Buerger Disease)." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2019. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116597/all/Thromboangiitis_Obliterans__Buerger_Disease_.
Thromboangiitis Obliterans (Buerger Disease). In: Stephens MB, Golding J, Baldor RA, et al, eds. 5-Minute Clinical Consult. 27th ed. Wolters Kluwer; 2019. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116597/all/Thromboangiitis_Obliterans__Buerger_Disease_. Accessed April 25, 2019.
Thromboangiitis Obliterans (Buerger Disease). (2019). In Stephens, M. B., Golding, J., Baldor, R. A., & Domino, F. J. (Eds.), 5-Minute Clinical Consult. Available from https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116597/all/Thromboangiitis_Obliterans__Buerger_Disease_
Thromboangiitis Obliterans (Buerger Disease) [Internet]. In: Stephens MB, Golding J, Baldor RA, Domino FJ, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2019. [cited 2019 April 25]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116597/all/Thromboangiitis_Obliterans__Buerger_Disease_.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Thromboangiitis Obliterans (Buerger Disease) ID - 116597 ED - Stephens,Mark B, ED - Golding,Jeremy, ED - Baldor,Robert A, ED - Domino,Frank J, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116597/all/Thromboangiitis_Obliterans__Buerger_Disease_ PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -